title: Counselor attitudes toward the use of naltrexone in substance abuse treatment: a multi-level modeling approach.
abstract: Alcohol use disorders (AUDs) continue to be one of the most pervasive and costly of the substance use disorders (SUDs). Despite evidence of clinical effectiveness, adoption of medications for the treatment of AUDs is suboptimal. Low rates of AUD medication adoption have been explained by characteristics of both treatment organizations and individual counselor's attitudes and behaviors. However, few studies have simultaneously examined the impact of organizational-level and counselor-level characteristics on counselor perceptions of EBPs. To address this gap in the literature, we use data from a national sample of 1178 counselors employed in 209 privately funded treatment organizations to examine the effects of organizational and individual counselor characteristics on counselor attitudes toward tablet and injectable naltrexone. Results of hierarchical linear modeling (HLM) show that organizational characteristics (use of tablet/injectable naltrexone in the program, 12-step orientation) were associated with counselor perceptions of naltrexone. Net of organizational characteristics, several counselor level characteristics were associated with attitudes toward tablet and injectable naltrexone including gender, tenure in the field, recovery status, percentage of AUD patients, and receipt of medication-specific training. These findings reveal that counselor receptiveness toward naltrexone is shaped in part by the organizational context in which counselors are embedded.
authors.affiliation: Institute for Behavioral Research, Center for Research on Behavioral Health and Human Services Delivery, University of Georgia, 112 Barrow Hall, Athens, GA 30602, USA; Department of Sociology, University of Georgia, Athens, GA 30602, USA. Electronic address: aabraham@uga.edu.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Abraham
authors.affiliation: Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Traci
authors.initials: T
authors.lastname: Rieckmann
authors.affiliation: Department of Sociology, University of Georgia, Athens, GA 30602, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: McNulty
authors.affiliation: Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kovas
authors.affiliation: Institute for Behavioral Research, Center for Research on Behavioral Health and Human Services Delivery, University of Georgia, 112 Barrow Hall, Athens, GA 30602, USA; Department of Sociology, University of Georgia, Athens, GA 30602, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Roman
mesh_terms: D001291:Attitude of Health Personnel; D003376:Counseling / Q000193:education*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009271:Naltrexone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D019966:Substance-Related Disorders / Q000188:drug therapy*; D013607:Tablets / Q000008:administration & dosage; D014481:United States
chemical_list: D009292:Narcotic Antagonists; D013607:Tablets; D009271:Naltrexone